Journal of Cardiovascular and Thoracic Research
Volume:11 Issue: 4, Nov 2019

Risk of diabetes mellitus type 2 (T2DM) is variable between individuals due to different metabolic phenotypes. In present network meta-analysis, we aimed to evaluate the risk of T2DM related with current definitions of metabolic health in different body mass index (BMI) categories.

Relevant articles were collected by systematically searching PubMed and Scopus databases up to 20 March 2018 and for analyses we used a random-effects model. Nineteen prospective cohort studies were included in the analyses and metabolically healthy normal weight (MHNW) was considered as the reference group in direct comparison for calculating indirect comparisons in difference type of BMI categories.

Total of 199403 participants and 10388 cases from 19 cohort studies, were included in our network meta-analysis. Metabolically unhealthy obesity (MUHO) group poses highest risk for T2DM development with 10 times higher risk when is compared with MHNW (10.46 95% CI; 8.30, 13.18) and after that Metabolically unhealthy overweight (MUOW) individuals were at highest risk of T2DM with 7 times higher risk comparing with MHNW (7.25, 95% CI; 5.49, 9.57). Metabolically healthy overweight and obese (MHOW/MHO) individuals have (1.77, 95% CI; 1.33, 2.35) and (3.00, 95% CI; 2.33, 3.85) risk ratio for T2DM development in comparison with MHNW respectively.

In conclusion we found that being classified as overweight and obese increased the risk of T2DM in comparison with normal weight. In addition, metabolically unhealthy (MUH) individuals are at higher risk of T2DM in all categories of BMI compared with metabolically healthy individuals.

This study was conducted to determine the relation between exposure to particulate matter less than 10 microns (PM10) caused by dust storms and the risk of cardiovascular, respiratory and traffic accident missions carried out by Emergency Medical Services (EMS).

This was a time-series study conducted in Dezful city, Iran. Daily information on the number of missions by the EMS due to cardiovascular, respiratory and crash problems and data on PM10 were inquired from March 2013 until March 2016. A generalized linear model (GLM) with distributed lag models (DLMs) was used to evaluate the relation between the number of EMS missions and the average daily PM10. The latent effects of PM10 were estimated in single and cumulative lags, up to 14 days.

In the adjusted model, for each IQR increase in the average daily PM10 concentration, the risk of EMS missions in the total population in single lags of 2 to 7 days, and the cumulative lags of 0-7 and 0-14 days after exposure had a 0.8, 0.8, 0.8, 0.8, 0.7, 0.6, 6.7 and 1.4% significant increase. Also, for each IQR increase in the daily mean concentration of PM10 in single 1 to 7, and cumulative lags of 0-2, 0-7, and 0-14 days after exposure, respectively, a 2.4, 2.7, 2.8, 2.9, 2.9, 2.7, 2.5, 7.4, 23.5 and 33. 3 % increase was observed in the risk of EMS cardiovascular missions.

Increase in daily PM10 concentrations in Dezful is associated with an increase in the risk of EMS missions in lags up to two weeks after exposure.

Dietary intake is a risk factor related to elevated blood pressure (EBP). Few studies have investigated an association of dietary glycemic index (GI) and glycemic load (GL) with the EBP. The aim of the current study was to examine the association of dietary GI and GL with the EBP among a group of healthy women.

This population-based cross-sectional study was conducted on 306 healthy women. Dietary GI and GL were measured using a validated semi-quantitative food frequency questionnaire (FFQ). Blood pressure (BP) was measured twice by a mercury sphygmomanometer from the right arm. Anthropometric measurements were also assessed according to the standard protocols.

Before controlling for potential confounders, no significant association was seen between dietary GI/GL and SBP/DBP. Also after controlling for potential confounders, the associations did not change between dietary GI and SBP (odds ratio [OR]: 0.96; 95% CI: 0.42-2.17, P = 0.87), between GI and DBP (OR: 0.72; 95% CI: 0.35-1.45, P = 0.37), as well as between GL and SBP (OR: 1.04; 95% CI: 0.43-2.49, P = 1.00) and between GL and DBP (OR: 1.20; 95% CI: 0.56-2.00, P = 0.61). In a stratified analysis by obesity and overweight, differences between tertiles of GI were not significant (OR: 0.75; 95% CI: 0.42-1.31, P = 0.31), even after adjustment for the potential confounders (OR: 1.54; 95% CI: 0.70-3.40, P = 0.26).

This study did not show a significant association between dietary GI/GL and the risk of high SBP/DBP. In addition, no significant association was found between dietary GI/GL and odds of overweight or obesity in adult women.

The purpose of this study was to obtain the cutoff points of visceral adiposity index (VAI), a new marker of indirect evaluation of visceral fat, to assess its association with metabolic syndrome (MetS) in a population of children and adolescents.

This cross sectional study was conducted on children and adolescents aged 7-18 years attended in the fifth phase of a national school-based surveillance survey. The odds ratio (OR) of cardiometabolic risk factors across tertile categories of VAI was determined using the logistic regression models and the valid cut-off values of VAI for predicting MetS was obtained using the receiver operation characteristic (ROC) curve analysis.

A total of 3843 students (52.3% boys, 12.3 [12.2-12.4] years) were included in the analysis. The mean of VAI was significantly higher in participants who had MetS (2.60 [2.42-2.78] vs 1.22 [1.19-1.25]; P <0.001). Participants in the third tertile compared to the first tertile category of VAI had higher odds of abdominal obesity (OR: 1.77, 95% CI: 1.43-2.20), impaired fasting blood glucose (OR: 2.00, 95% CI: 1.28-3.13) and low high-density lipoprotein cholesterol (OR: 15.93, 95% CI: 12.27-20.66). The cut-off points of the VAI for predicting MetS were 1.58, 1.30 and 1.78 in total population, boys and girls, respectively.

We determined the cut-off points of VAI as an easy tool for detecting MetS in children and adolescents and demonstrated that VAI is strongly associated with MetS. Prospective longitudinal studies are suggested to show the possible efficiency of the VAI as a predictor of MetS in pediatrics.

Congenital heart disease (CHD) affects 1% to 2 % of live births. The Nkx2-5 gene, is known as the significant heart marker during embryonic evolution and it is also necessary for the survival of cardiomyocytes and homeostasis in adulthood. In this study, Nkx2-5 mutations are investigated to identify the frequency, distribution, functional consequences of mutations by using computational tools.

A complete literature search was conducted to find Nkx2-5 mutations using the following key words: Nkx2-5 and/or CHD and mutations. The mutations were in silico analyzed using tools which predict the pathogenicity of the variants. A picture of Nkx2-5 protein and functional or structural effects of its variants were also figured using I-TASSER and STRING.

A total number of 105 mutations from 18 countries were introduced. The most (24.1%) and the least (1.49%) frequency of Nkx2-5 mutations were observed in Europe and Africa, respectively. The c.73C>T and c.533C>T mutations are distributed worldwide. c.325G>T (62.5%) and c.896A>G (52.9%) had the most frequency. The most numbers of Nkx2-5 mutations were reported from Germany. The c.541C>T had the highest CADD score (Phred score = 38) and the least was for c.380C>A (Phred score=0.002). 41.9% of mutations were predicted as potentially pathogenic by all prediction tools.

This is the first report of the Nkx2-5 mutations evaluation in the worldwide. Given that the high frequency of mutation in Germany, and also some mutations were seen only in this country, therefore, presumably the main origin of Nkx2-5 mutations arise from Germany.

According to the several evidences, using thromboelastometry as a point of care test canbe effective in reduction in blood loss and transfusion requirements in cardiac surgeries. However,there are limited data regarding to the comparison of thromboelastometry and the standard coagulationtests. In this study, we compared thromboelastometry and standard coagulation tests (PT, PTT andfibrinogen level) in patients under combined coronary-valve surgery.

Forty adult patients who were under on-pump combined coronary-valve surgery wereincluded in this study. Thromboelastometry tests Fibtem, Intem, Extem and Heptem), along withstandard coagulation tests (PT, PTT and fibrinogen assay) were simultaneously performed in two timepoints, before and after the pump (pre-CPB and post-CPB, respectively).

A total of 80 blood samples were analyzed. There were no significant correlation between PTtest and the CT-Extem parameter as well as PTT and CT-Intem parameter either in pre-CPB and post-CPB (P > 0.05). On the contrary, fibrinogen level had high correlation with A10-Fibtem and A10-Extemin pre-PCB (P < 0.05). 82% of PT and 84% of PTT measurements were outside the reference range,while abnormal CT in Extem and Intem was observed in 17.9%.

For management of bleeding, adequate perioperative haemostatic monitoring isindispensable during cardiac surgery. Standard coagulation tests are time consuming and cannot beinterchangeably used with thromboelastomety and relying on their results to decide whether bloodtransfusion is necessary, leads to the inappropriate transfusion.

Considering the increased expenditure in public health sector, especially the increased cost in hospitals and clinics, there is an urgent need to control these costs mainly by ensuring adherence to clinical guidelines for diagnostic procedures. In this study we aim to investigate the adherence of heart clinics to guideline for exercise tolerance test.

This cross-sectional study was performed on 308 patients who were referred for ECG exercise test in 3 clinics located in the city of Shiraz, Iran in 2018. Demographic and clinical data were recorded and the indications of exercise test for each patient was reviewed according to the ACC/AHA guideline for exercise tolerance test.

Exercise tests were found to be inappropriately done in 121 (39.3%) participants. Among the patients for whom the test was done without indication 79 (65.3%) were women and the gender difference was statistically significant (P < 0.01); women were 18.5% more likely to undergo exercise test without indication. There was more inappropriate tests among nonanginal pain subsets comparing to other presenting symptoms (P < 0.001). Age, coronary risk factors, reason for performing exercise tests and private health system were not predictors of inappropriate use (P > 0.05).

This study confirms that more than one third of exercise tests done in the participants are inappropriate. Wide availability of exercise test makes it vulnerable to overuse and additional unnecessary cost to health care systems.

In light of previous studies reporting the significant effects of preeclampsia on cardiac dimensions, we sought to evaluate changes in the left ventricular (LV) systolic and diastolic functions in patients with preeclampsia with a view to investigating changes in cardiac strain.

This cross-sectional study evaluated healthy pregnant women and pregnant women suffering from preeclampsia who were referred to our hospital for routine healthcare services. LV strain was measured by 2D speckle-tracking echocardiography.

Compared with the healthy group, echocardiography in the group with preeclampsia showed a significant increase in the LV end-diastolic diameter (47.43 ± 4.94 mm vs 44.84 ± 4.30 mm; P = 0.008), the LV end-systolic diameter (31.16 ± 33.3 mm vs 29.20 ± 3.75 mm; P = 0.008), and the right ventricular diameter (27.93 ± 1.71 mm vs 24.53 ± 23.3; P = 0.001). The mean global longitudinal strain was -18.69 ± 2.8 in the group with preeclampsia and -19.39 ± 3.49 in the healthy group, with the difference not constituting statistical significance (P = 0.164). The mean global circumferential strain in the groups with and without preeclampsia was -20.4 ± 12.4 and -22.68 ± 5.50, respectively, which was significantly lower in the preeclampsia group (P = 0.028).

The development of preeclampsia was associated with an increase in the right and left ventricular diameters, as well as a decrease in the ventricular systolic function, demonstrated by a decline in global circumferential strain.

There is no agreement on how the hands are positioned in cardiopulmonary resuscitation (CPR). In this study, the effects of two methods of positioning the hands during basic and advanced cardiovascular life support on the chest compression depth are compared.

In this observational simulation, the samples included 62 nursing students and emergency medicine students trained in CPR. Each student performed two interventions in both basic and advanced situations on manikins and two positions of dominant hand on non-dominant hand, and vice versa, within four weeks. At each compression, the chest compression depth was numerically expressed in centimeter. Each student was assessed individually and without feedback.

The highest mean chest compression depth was related to Basic Cardiovascular Life Support (BCLS) and the position of the dominant hand on non-dominant hand (5.50 ± 0.6) and (P = 0.04). There was no statistically significant difference in the basic and advanced regression variables in men and women except in the case of Advanced Cardiovascular Life Support (ACLS) with dominant hand on non-dominant hand (P = 0.018). There was no significant difference in mean chest compression during basic and advanced cardiovascular life support in left- and right-handed individuals (P = 0.09).

When the dominant hand is on the non-dominant hand, more pressure with greater depth is applied.

The advent of multi-slice computed tomography (CT) technology has provided a new promising tool for non-invasive assessment of the coronary arteries. However, as the prognostic outcome of patients with normal or non-significant finding on computed tomography coronary angiography (CTCA) is not well-known, this study was aimed to determine the prognostic value of CTCA in patients with either normal or non-significant CTCA findings.|

This retrospective cohort study was performed on patients who were referred for CTCA to the hospital. 527 patients with known or suspected coronary artery disease (CAD), who had undergone CTCA within one year were enrolled. Among them, data of 465 patients who had normal (no stenosis, n=362) or non-significant CTCA findings (stenosis <50% of luminal narrowing, n=103) were analyzed and prevalence of cardiac risk factors and major adverse cardiac events (MACE) were compared between these groups. In addition, a correlation between these factors and the number of involved coronary arteries was also determined.

After a mean follow-up duration of 13.11±4.63 months, all cases were alive except for three patients who died by non-cardiac events. Prevalence of MACE was 0% and 3% in normal CTCA group and non-significant groups, respectively. There was no correlation found between the number of involved coronary arteries and the prevalence of MACE (P = 0.57).

A normal CTCA could be associated with extremely low risk of MACE over the first year after the initial imaging, whereas non-significant obstruction in coronary arteries may be associated with a slightly higher risk of MACE.

This study aimed to present a case of 33-year old man who was admitted with a history of one week headache and acute diplopia. No important finding was reported in his past medical history. Brain CT-scan revealed a large mass lesion in left parieto-occipital area with prominent vasogenic edema and midline shift. Brain magnetic resonance imaging (MRI) showed a mass with size of 5*4*5 centimeter with ring enhancement. After cranial surgery and removing the mass, transthoracic and transesophageal echocardiography (TEE) were conducted to find the source of brain abscess. Right ventricular (RV) and right atrial (RA) enlargement, significant left to right shunt, normal left ventricular (LV) and RV function, bidirectional shunt in addition to moderate size superior sinus venosus type atrial septal defect (ASD) were detected. Considering that most of brain abscesses have hematogenous source, a complete cardiac evaluation including TEE with contrast study is suggested for evaluation of patients with brain abscess.

Acute pulmonary embolism (APE) may lead to life-threatening conditions such as cardiac death and congestive heart failure. Thus, a proper diagnosis and management play a crucial role to prevent such complications. Moreover, APE is a rare clinical onset of chronic myeloproliferative disease. We herein describe a 67-year-old patient with polycythemia vera presented to our cardiology clinic with pulmonary embolism despite the fact that an intense antiplatelet treatment started secondary to acute myocardial infarction prior. Because the patient had hypotension and head trauma, rheolytic thrombectomy was performed successfully to restore adequate pulmonary perfusion.